Transcatheter aortic valve replacement (TAVR) is increasingly performed in patients who are at high surgical risk for surgical aortic valve replacement. The frequency of coronary artery disease is as high as 70 percent in patients with severe aortic stenosis. It is routine practice to perform preoperative coronary angiography and PCI in patients for whom TAVR is planned. However, many patients require post-TAVR coronary angiography and intervention. Depending on the type of the percutaneous valve, this may not be as easy as it is in the absence of a percutaneous valve. In this tip of the month, we discuss nuances and tips and tricks that can be employed for coronary angiography in these patients.

SCAIReview sessions are rated one of the most engaging events at SCAI Scientific Sessions. We come together as a clinical community, review our most challenging and unusual cases, share our knowledge and techniques and discuss the ways our colleagues managed complications.

Physicians are invited to submit their most interesting and challenging cases across the following topic areas:

SCAIPlease nominate a deserving colleague for the Master Interventionalist of SCAI (MSCAI) designation and the Helping Hearts Lifetime Service Award!

The MSCAI designation and Helping Hearts Lifetime Service Award were established to recognize those invasive/interventional cardiologists who have dedicated their careers to SCAI and the field of Interventional Cardiology.

Help SCAI honor those who demonstrate excellence in invasive/interventional cardiology and a commitment to the highest levels of clinical care, innovation, publications and teaching.

MedPage TodayWhen done before a repeated trans-radial intervention, vascular ultrasound scanning reduced vascular access times by 3.5 minutes on average, and procedure times were cut by more than 10 minutes, according to a trial in Catheterization and Cardiovascular Interventions.READ MORE

TCTMDCompared with open surgery, endovascular repair of ruptured abdominal aortic aneurysms (AAAs) yields better clinical and survival advantages, better quality of life for patients and savings for the healthcare system, according to midterm outcomes from the IMPROVE trial.
Although early data from the trial showed no differences between the two strategies in terms of mortality, the rate of death by three years was lower among those treated with EVAR compared with surgery.
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PulsaraSt. Elizabeth Healthcare, in Edgewood, Kentucky, serves a population of more than 400,000 across the Greater Cincinnati area, from Northern Kentucky to Indiana and Ohio. At St. Elizabeth, like most health systems in the U.S., there was no overarching way to organize all the different cardiac team members and stakeholders, which could cause treatment delays and disorganization. After adopting a set of recommended changes in the process of responding to heart attack patients including the implementation of Pulsara, the time from first medical contact to the moment of artery-opening treatment dropped 30 percent. See the full story here.READ MORE

HealioPatients with atrial fibrillation who underwent percutaneous coronary intervention and were treated with dual therapy — dabigatran plus a P2Y12 inhibitor — had consistent benefits across subgroups compared with those treated with triple therapy — warfarin plus a P2Y12 inhibitor plus aspirin.
Subgroups included patients who received either drug-eluting or bare-metal stents, those with and without acute coronary syndrome and those with clopidogrel or ticagrelor (Brilinta, AstraZeneca) as their P2Y12 inhibitor.
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MD MagazineThe optimal duration of dual anti-platelet therapy for patients with acute coronary syndrome should be customized based on individual patient characteristics, particularly ischemic/bleeding risk, presence of diabetes and type of stent, according to a presentation at the 2017 Multidisciplinary Cardio-Endo Renal Collaborative meeting.
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TCTMDSodium-glucose co-transporter 2 inhibitors, designed for the treatment of diabetes, appear to be effective at reducing a major adverse cardiac event in the setting of peripheral artery disease, according to new trial findings. Yet data from another study suggest these agents are less well suited to primary prevention in diabetic patients without prior cardiovascular disease.READ MORE

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PRODUCT SHOWCASE

Reduce Dye. Reduce Risk.Society guidelines state the need to reduce dye in high risk patients as part of a strategy to reduce risk of AKI in the cath lab. Osprey Medical’s DyeVert™ Plus System is the only technology proven to consistently monitor and reduce dye dosage delivered to patients undergoing coronary angiography procedures.

HealioPatients with pulmonary artery hypertension who were treated with ralinepag in addition to single or dual background therapy had improved pulmonary vascular resistance compared with those treated with placebo, according to data presented at the CHEST annual meeting.
"It was ... a clinically meaningful effect that portends an improvement through something that would correspond in most cases with an improvement in terms of their symptoms, but more importantly in terms of their long-term outcomes," Vallerie V. McLaughlin, MD, professor at University of Michigan Medical School in Ann Arbor, told Cardiology Today. READ MORE